体外循环术后TEG监测值与胸腔引流量和输血量的相关性研究

Correlation of TEG Between the Thoracic Drainage and Blood Transfusion After CPB

【目的】通过血栓弹力描记图(TEG)的监测和传统凝血功能监测了解体外循环后凝血功能的改变,比较两者与术后出血量(胸腔引流量)和输血量的相关性,评估TEG在体外循环手术中的监测意义。【方法】24例病人分别在术前、肝素中和后10 min、肝素中和后的3 h抽血监测TEG和凝血三项(凝血酶原时间:PT,活化全血凝固时间:aPTT;纤维蛋白原:Fb)。记录病人回ICU后不同时间点的引流量以及病人总的输血量。比较病人在体外循环后凝血功能的变化,并分别作肝素中和后10 min时的监测结果与不同时间点引流量和总输血量的相关性分析。【结果】①病人的凝血功能在体外循环后都受到了明显的损害(P<0.01);②病人的引流量、输血量和监测值有一定的相关性,而TEG的监测值比凝血三项相关性好。【结论】TEG和凝血三项都能反映出体外循环后病人凝血功能的损伤,而TEG与术后的出血量及输血量的相关性更好,能对临床治疗起到有效的监测和一定的指导作用。

[Objective]To find out the change of blood clotting after cardopulmonary bypass （CPB） by thromboelastography （TEG） and compare the correlation between the thoracic drainage and blood transfusion. [Methods]Twenty-four patients were checked the TEG, prothrombin time （PT）, activated partial thromboplastin time （aPTT） and fibrinogen （Fb） before CPB,10 min .3 h after heparin neutralized. The drainage at different times, the total requirement of blood were recorded. The change of blood clotting and the correlation between TEG 10 min after heparin neutralization and the thoracic drainage at different times and the total blood transfusion were analyzed comparatively. [Resuhs]①The blood clotting was significantly impaired after CPB（ P 〈0.01）. ②There were some correlations among the thoracic drainage, the TEG results and blood transfusion. [Conclusion] TEG,PT,aPTT and Fb can reflect the impairment of the blood clotting after CPB, TEG is an effective monitoring method, and can give some guidance to the clinic therapy.